Root canal and crown

Hey all,

I don't know if you know this but it has been raining for 3 straight days here. I am not talking about drizzling, it is pouring on and off all day and night.

We lost power at my house for a couple of hours on Monday. When the power came back one of my thermostats failed to work. Now I don't know about other states but if you don't have air conditioning in Florida you are one sweating miserable individual.

So I went to Home Depot and bought a thermostat and tried to install it.

You know the thing that on the outside of the package it says "EASY TO INSTALL".

Yeah, well I forgot to read the fine print and it says, "easy to install" alright but I guess some on the package it must read, "if you are an electrical engineer".

So after my third trip to Home Depot and my third attempt to install a thermostat myself, I called the air conditioner guy.

He came out the next day and told me I did it right I just didn't program the thermostat properly.

So I paid $80 for a house call to have the air conditioner guy program my thermostat.

Arghhhhh!

But one of the reasons I didn't write on Monday was because of the power outage, the air conditioner and my neighbor.

Yeah, during the storm I heard two booms. I looked outside and I think the first boom was from lightning hitting a branch of my neighbors tree and the second boom was the tree branch hitting his house.

By the time I saw it it had fallen to the ground. Not really any damage to the house.

I called another dude that lives in my neighborhood, goes to my church, lives just down the street, and has a chain saw.

I told him, "let's bless my neighbor and get this huge branch off his house and clean it up."
He said okay and was down the street in about 5 minutes with the chain saw.

We did it in about an hour. We stacked up the big pieces and piled up the tiny branches.

I didn't tell him it was us. I just wanted to bless him and not get any credit for it.

But I have to tell you...it is killing me. Not being able to tell him it was me that did it.

I have talked to him a couple of times since Monday and I am dying. I don't even know if he even knows the branch fell.

My neighbor came home and things were clean and there were piles of stuff in the lawn.

I am dying right now. I want credit. I know, I know, I know I am not suppose to want it but I do. Man do I have a long way to go.

In my younger days I hated to read. I read but only when my teacher told me to.

Now I am going back and reading the classics.

In the same light I am going back and watching the classic movies. I watched Casablanca this weekend. It was okay. Nothing that blew my socks off. I think for the 40's it was very well done. But, what can I say, it was done in the 40's.

I followed this one up with Bedtime Stories. It was good. Nothing great...just good.

I am reading a book called The Glass Castle. I think I told you a week ago or so. It is very good.

I will recap later.

Today's topic.
I wanted to talk about crowns after root canals.

Mainly I want to talk about posterior root canals and crowns (premolars and back).

I have to tell you, and I don't want you to think bad about me....I don't crown every root canal tooth.

I don't know if there has been any studies in the last 15 years about bonding teeth and root canals but I have done my own.

My studies are a little less technical than the scientists.

I have a 17 year old patient that has a very good DO resin on #13. If I did the filling I know it is conservative but it still could have been deep. I know the filling is good. But now she comes in with an abscess. I do a very conservative access on this one canal tooth.

The patient can't afford the crown.

I do an access filling. Thus starting my study.

I have been "studying" this way for 14 years. I can count on one hand how many times this way has backfired on someone. Now if it backfires I don't remember even one where we had to extract the tooth. It is more like they broke the tooth and it now can't be fixed with a filling. So we just do a crown (and now usually a better financial time than before).

Let me show you a picture.

All the decay removed and pulpectomy done. I think this patient was saving money for each step.

Root canal completed...now what?

Are you going to tell me this is wrong? Are you going to tell me that I need to do a $1200 onlay to save this tooth? I don't buy it.

And I don't want to shock you but I do the same thing on molars.

If I do a MO resin on #18 and it just a little deep. The tooth abscesses and I have to do a RCT. Well I just fill the access filling. Tooth is fine.

And since we are being honest with each other I will tell you more. I don't care if it is a conservative filling or not.

I don't care if I put a build-up on the tooth. It is going to be okay in my hands.

Sometimes I will put a big filling on a tooth and tell the patient. "This is what dental school told me, that you need a crown. I don't know if I buy this anymore. I put a big filling on this tooth and I think it is going to be fine. When I see you every six months we will revisit this tooth. I don't think you are going to any problems. If you do then we will do a crown."

Now I have just saved this person at least 10 years without a crown.

Now again I don't know if this has been studied. I know that a non-vital tooth is weaker and that is why supposedly the tooth needs a crown but maybe there is study that shows that a bonded tooth is better than a tooth with an amalgam build-up.

It is for me.

Maybe the thought process has changed and my thought process is right on. Sometimes practicing dentistry feels like you are doing it on an island all by yourself.

I guess this is what the AGD and this blog are trying to alleviate.

Does anyone else have there own study going on?

Have a good Wednesday,

John